{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GABRIELLA GONSALVES","gend":1,"add":"7838 DIVEN ST APT 101","city":"NORFOLK","state":"VA","zip":23505,"dob":"2004-02-05","age":"","mstatus":"","insh":"2083640*01","cliId":"","pno":"757\/802-0093","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/461-6342","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"CMG - Children's Hospital of The King's Daughters - Pediatric Specialists - DePaul Office","plan":"OHP","program":"Medicaid","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/461-8507","pcpnpi":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.89","J30.81","J30.1","R11.10","R07.81","R05.","J30.2","S62.634A","S61.214A","M79.644","S62.609A","W23.0XXA","J45.991","U07.1","K21.9","R07.89","V54.12","W23.0XXD","J02.9","R07.9","K52.9","S90.512A","W54.0XXA","L08.9","L70.0","L81.9","Z71.9","N92.6","L01.00","H10.32","L70.9","D22.9","Z12.83","Z00.129","Z13.31","J30.9","J45.990","L20.89","J45.909","J45.20","Z68.52","Z23.","R73.09","F43.20","S00.81XA","F43.21","F33.1","F41.1","E11.9","R50.9","Z20.822","R41.840","R45.89","F41.9","E28.2","Z30.41","E66.3","S06.0X9A","S09.90XA","R11.0","Z11.3","R63.0","Z68.26"],"date":["2020-02-26","2020-02-26","2020-02-26","2020-02-14","2020-02-14","2020-02-14","2020-02-26","2019-06-05","2019-05-28","2019-05-28","2019-08-06","2019-08-06","2019-08-28","2021-12-23","2021-12-23","2021-12-23","2019-08-16","2019-08-16","2022-09-01","2021-12-23","2019-05-08","2020-10-08","2020-10-08","2020-11-04","2021-12-15","2021-12-15","2021-12-15","2021-02-10","2019-11-06","2019-11-08","2019-11-08","2019-09-11","2019-09-11","2020-10-07","2020-10-07","2019-04-22","2019-04-22","2019-04-22","2020-02-14","2020-10-07","2020-10-07","2020-10-07","2022-04-06","2022-04-07","2022-07-18","2022-05-17","2022-11-03","2022-11-03","2022-09-01","2022-08-29","2022-08-29","2022-02-16","2022-02-16","2022-09-01","2022-11-09","2022-11-09","2022-02-09","2022-07-19","2022-07-19","2022-07-19","2022-11-09","2022-09-01","2022-09-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00187510102","ELIDEL","CRE 0.01","60","Select","Select",""],["","53885001110","ONETOUCH","MIS PLUS 30G","100","Select","Select",""],["","68462072029","DROSPIRENONE","TAB ETHY EST","84","Select","Select",""],["","68180035109","SERTRALINE","TAB 25MG","30","Select","Select",""],["","70010049101","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","76439035890","L-METHYLFOLA","TAB 15MG","30","Select","Select",""],["","70010013901","NAPROXEN","TAB 500MG","20","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00006022131","JANUVIA","TAB 25MG","30","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","90","Select","Select",""],["","51672140004","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","11822000207","RA","TAB 25MG","16","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","11822334950","ALLERGY","CAP 25MG","16","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00456074613","AERCHMBR","MIS LRG MASK","2","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","41167580003","NASACORT","SPR 55MCG\/AC","11","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00299491015","DIFFERIN","GEL 0.001","15","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}